INHALED FLUTICASONE REDUCES SPUTUM INFLAMMATORY INDEXES IN SEVERE BRONCHIECTASIS

Although corticosteroid therapy might be clinically beneficial for bro nchiectasis, very little is known of its effects on the inflammatory a nd infective markers in bronchiectasis. We have therefore performed a double-blind, placebo-controlled study to evaluate the effects of a 4- wk administration of inhaled fluticasone in bronchiectasis. Twenty-fou r patients (12 female; mean age 51 yr) were randomized into receiving either inhaled fluticasone (500 mu g twice daily) via the Accuhaler de vice (n = 12) or placebo. At each visit, spirometry, 24-h sputum volum e, sputum leukocyte density, bacterial densities, and concentrations o f interleukin (IL)-1 beta, IL-8, tumor necrosis factor-alpha (TNF-alph a), and leukotriene B4 (LTB4) were determined. There was a significant (p < 0.05) decrease in sputum leukocyte density and IL-1 beta, IL-8, and LTB4 after fluticasone treatment. The fluticasone group had one an d the placebo group three episodes of exacerbation. There were no sign ificant changes in spirometry (p > 0.05) or any reported adverse react ions in either group. The results of this study show that high-dose fl uticasone is effective in reducing the sputum inflammatory indices in bronchiectasis. Large-scale and long-term studies are indicated to eva luate the effects of inhaled steroid therapy on the inflammatory compo nents in bronchiectasis.